NPIMap

Individual provider Active NPI

Audrey Petteruti, DO

  • Psychiatry Physician
  • Fayetteville, NC
National Provider Identifier
1902425853
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
202202150 Issued in NC
Practice address
711 Executive PL
Fayetteville, NC 28305-5193
Phone
(910) 615-3333
NPI assigned
Apr 10, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 202202150 NC Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

711 Executive PL
Fayetteville, NC 28305-5193

Mailing address

PO Box 40908
Fayetteville, NC 28309-0908
Phone (910) 615-6949

Other practice location 1

3425 Melrose Rd
Fayetteville, NC 28304-1608
Phone (910) 615-3610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, KY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240725001797 NC Practitioner - Psychiatry 1052734589 Reassigns benefits to 1 organization
I20260608004020 KY Practitioner - Psychiatry 1052734589 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of New England, College of Osteo Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

711 Executive PL
Fayetteville, NC 28305-5193
Phone (910) 615-3333

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
202202150NCMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland County Hospital System Inc Current Accepting new patients
Cumberland County Hospital System Inc Psychiatry CurrentSince May 13, 2024 Accepting new patients
Cumberland County Hospital System Inc CurrentSince May 13, 2024 Accepting new patients

Locations

3425 Melrose Rd
Fayetteville, NC 28304
Phone (910) 609-3700

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

Interoperability endpoints

  • Direct secure messaging: apetteruti80300@capefearvalley.direct-ci.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776297600000",
    "number": "1902425853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40908",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283090908",
            "telephone_number": "910-615-6949",
            "fax_number": "910-615-9761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 EXECUTIVE PL",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283055193",
            "telephone_number": "910-615-3333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3425 Melrose Rd",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283041608",
            "country_code": "US",
            "telephone_number": "910-615-3610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETTERUTI",
        "first_name": "AUDREY",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-10",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "202202150",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.